Clinical Characteristics Of 82 Cases With Hepatitis E In Guangzhou Area

ObjectiveTo explore the recent epidemiological characteristics and clinical features of hepatitis E in Guangzhou area.By comparing the hepatitis E and the superinfection of hepatitis B virus(HBV) with hepatitis E virus(HEV) in the similarities and differences of clinical characteristics,to clarify whether superinfection of HBV with HEV is more severe than the hepatitis E single infection, and to explore whether HEV can inhibit the replication of HBV.MethodsThe retrospective study was performed in the 82 hospitalized cases with hepatitis E patients, as well as 1018 cases of patients with chronic hepatitis B in the same period of hospitalization,all cases are from the First Affiliated Hospital of Jinan University.Diagnosis are made with the diagnostic criteria in "guideline of viral hepatitis prevention and treatment" which was established in Xi'an Meeting in 2000.ResultsOf the 82 cases of hepatitis E,65 were males and 17 were females,male to female ratio was 3.8:1.The average ages of patients were(43.4±17.2) years old and the youngest is a 3-year-old,the oldest is 75 years old.The majority of them are presents and workers.As for the seasonal character of the incidence of hepatitis E,difference could not be found.Acute jaundiced hepatitis account for the majority of the Hepatitis E,which is up to 68 cases(82.9%);and followed by 14 cases of acute non-jaundiced hepatitis.The fulminant type is relatively rare. Cholestatic is more common in older patients.Fulminant hepatitis was more often seen in the patients with hepatitis E complicated with other liver disease,such as other viral hepatitis, alcoholic liver disease,drug-induced hepatitis and so on.Most patients with hepatitis E have shown poor appetite,nausea,vomiting and other gastrointestinal symptoms.The damage of liver function was obvious.In different age groups,there was no significant difference in the extent of damage of liver cells.But in older patients,cholestatic hepatitis is more common,and normalization of liver function would take relatively much time,in the other word,the old patients would stay in hospital longer and the prognosis was also poor.Of the 82 cases,the patients with only hepatitis E were 33 cases(40.2%).Other 41 cases infected with HEV were superinfected or coinfected with other chronic viral hepatitis,like chronic hepatitis B or chronic hepatitis C.According to our study,the 25 patients superinfected with HBV infection was more difficult to recover from liver damage than a the single hepatitis E.Using ELISA(Enzyme-linked immunosorbent assay) to detect HBV markers in the sera of the patients,dividing the 25 cases of hepatitis E superinfected with HBV as group A and the 1018 cases with chronic hepatitis B only as group B.By comparative analysis,the positive rates of HBeAg and HBV DNA in sera of group A was lower than in group B(P＜0.05).ConclusionHepatitis E had not significant seasonal distribution,most of the patients had the history of dining out of home.The most risk age is in young adults,followed by the elderly and then children.The most common clinical type of Hepatitis E is acute jaundiced type,followed by acute non-jaundiced.Cholestatic type was mainly in elderly patients.In elderly patients the prognosis and outcome are quite poor.Superinfection of HEV with HBV had more severe liver damage and the liver function recover more slowly.HEV infection may have an inhibitive effect on the HBV replication in some extent.Superinfection with other hepatitis virus, immunosuppressive therapy,chronic liver disease,old age may be risk factors for fulminant hepatitis E.